| The aging of population and the extension of the life span of the old with disability have created a large number of long-term care needs,at the same time,the decline in fertility,the growth rate of women's labor participation and the increase in the proportion of the elderly who living alone have greatly reduced the accessibility of informal care resources,China is facing a huge contradiction between the ever-increasing demand for long-term care and the continuous shortage of care resources.The shortage of informal care resources and the high cost of formal care have brought serious damage and impact to the health and welfare of the disabled elderly and their economic foundation.To properly solve the problem of long-term care for the disabled elderly,it is necessary not only to enhance the accessibility of care services,but also to establish a long-term mechanism of risk dispersion of long-term care.Promoting health and protecting people's livelihood is an important part of our government's national governance and strategic deployment.For example,the 19th National Congress of the Communist Party of China,the Fourth Plenary Session of the 19th Central Committee,and the latest two sessions in 2020 all emphasize to improve and perfect the level and intensity of people's livelihood security.Under this background,our country launched the first batch of long-term care insurance pilot policies in 2016 and the second batch of expanded pilot policies in 2020.But we must deeply understand that the current coverage of China's long-term care insurance is still very limited.Among 660 cities in China,only 49 regions are conducting pilot projects,though it is not yet included in the vast rural areas,this shows that the development of long-term insurance in China is very seriousIn order to solve the common long-term care problems of the disabled elderly,we should not only to make a long-term forecast of the development situation of the disabled elderly's who have long-term care needs from the micro perspective,so as to accurately grasp the overall situation of the disabled elderly in the future in China,but also to explore the relationship between formal care and informal care from the perspective of the preference of the disabled elderly's care needs.When individuals are disabled and need to seek care service and choose care mode,they not only pay attention to the cost of the care,but also pay attention to their psychological demands(care preference).Whether there is a significant alternative relationship between formal care and informal care determines whether formal care resources can be effectively used when informal care resources are in short supply.Although the implementation of long-term care insurance can effectively disperse the high cost of formal care,but it can not guide the demand for formal care absolutely.The scientificity and effectiveness of its policy implementation still depend on the substitution degree of formal care for informal care.Therefore,whether there is significant substitution between formal care and informal care has a great impact on the necessity and scientificity of the pilot policy of long-term insuranceIn addition,the implementation effect of the long-term care insurance pilot policy is related to whether the long-term care of the disabled elderly can be obtained and properly settled.Compared with the newly announced expansion pilot policy in 2020,the first batch of pilot policies has been implemented for more than four years since the date of announcement,and the effects of the pilot policies need to be evaluated urgently.The evaluation of the long-term care insurance pilot policy can not only improve the scientificity of long-term care insurance policy formulation,but also an inherent requirement for the upgrade and optimization of modern public policies.In order to properly solve the problem of long-term care for the disabled elderly and consolidate the development results of the long-term care insurance pilot policy,this article has carried out research based on the long-term care demand and its insurance pilot policy evaluation research,and the main conclusions are as followsFirst,the long-term care needs and long-term care costs of the disabled elderly in my country are growing rapidly.Forecast data show that the total scale of disabled elderly and the severely in my country will fluctuate between 42.58 and 228.77 million and 3.43-55.22 million respectively from 2020 to 2060.The fluctuation range of long-term care costs for disabled elderly in China is 72.8?18,233.5 billion yuan.The above data shows that it is necessary to establish a long-term mechanism for dispersing the risk of long-term care for disabled elderly people,which also reveals the necessity and urgency of carrying out long-term care insurance policy trials.Second,there is a significant substitution relationship between formal care and informal care.Specifically,there is a significant substitution relationship between informal care and the utilization of domestic services and the admission to nursing homes.In terms of the degree of substitution,the substitution effect of domestic services and informal care is greater than that of nursing home services and informal care.The degree of disability does not affect the alternative relationship between family care and formal care.This is because the cost of formal care is higher,which exceeds the affordability of many middle-income families.After the local pilot program of long-term care insurance is launched,the high cost of formal care will be effectively dispersed by long-term care insurance,and the unmet need for care of disabled elderly people will be compensated through the use of formal care services.That is to say,the implementation of the long-term care insurance pilot policy may improve the accessibility of nursing services by optimizing the care structure of the disabled elderly;In addition,the development of the pilot long-term care insurance policy may be implemented through medical treatment and nursing care for the disabled elderly separately to reduce the over-utilization of medical resources by elderly care effectively;Finally,the basic principle of the implementation of the long-term care insurance pilot policy is to improve people's health.Based on the above analysis,it can be seen that the positive effects of the long-term care insurance pilot policy may have three points:one is to improve the accessibility of care services for the disabled elderly;the second is to reduce the inefficient allocation of medical resources that is excessively squeezed by social admissions;and the last is to improve the health of disabled elderly people.This article will verify this one by one in chapter five.Third,the pilot policy of long-term care insurance is effective.The implementation of long-term care insurance has reduced the overuse of medical resources by disabled elderly people in the pilot areas;Specifically,the implementation of the pilot policy of long-term care insurance can reduce the monthly outpatient expenses and the number of outpatient visits by the disabled elderly by 316 yuan and 0.819 times respectively.The annual hospitalization costs and the number of hospitalizations for the disabled elderly were reduced by 5262.1 yuan and 0.464 times respectively.Secondly,the development of long-term care insurance improved the health of disabled elderly in the pilot area;Specifically,the implementation of the long-term care insurance pilot policy reduced the number of chronic diseases of disabled elderly by 0.136 and reduced their health self-assessment score by 0.128(the smaller the health self-assessment value,the higher the health level).Finally,the development of long-term care insurance has changed the long-term care structure of disabled elderly people in pilot areas and improved the accessibility of care services for disabled elderly people.Specifically,the implementation of the long-term care insurance pilot policy has increased the likelihood of disabled elderly being cared for by 8.75%,and reduced the likelihood of informal care use by 20.9%Fourth,comparing the development practice of the first batch of 15 pilot cities for long-term care insurance,it is found that there are still some problems in long-term care insurance in my country.The diversified financing mode of most pilot areas is only on the surface,and the main financing source of long-term care insurance fund is the surplus of medical insurance fund,which does not reflect the payment responsibility of individuals and companies.In terms of benefits,only a small number of regions(four)truly adhere to the concept of "encouraging home care and community care" in the pilot guidelines;The diversity status of disability assessment standards is not conducive to the unification and development of future long-term care insurance.As the methods of disability assessment of Guangzhou,Chengdu,Jingmen and Qingdao are basically in line with international standards,the future disability assessment methods of long-term care insurance should focus on the experience of these four citiesFifth,a comparative analysis of the development practice of long-term care insurance in Japan,Germany and China,we believe that the development and improvement of my country's long-term care insurance system need to be carried out in the three following aspects:to build a sustainable financing mechanism for long-term care insurance;to build a multi-level and multi-functional long-term care service system;and to speed up and improve the long-term care insurance and legal system construction related to long-term care security.Sixth,policy recommendations.The implementation of the long-term care insurance pilot policy has promoted the transition from home care to social care.As the foundation of home care in our country is getting weaker,the long-term care insurance pilot policy undoubtedly guarantees the widespread demand for long-term care services for the elderly in the state of disability and also improve the welfare level of disabled elderly.In addition,the pilot policy of long-term care insurance solves the problem of shortage of medical resources caused by social admissions,and at the same time improves the health of disabled elderly people.These conclusions provide certain reference significance and data support for the further development of long-term protection insurance pilot policies.Based on the previous research results,the following improvements are achieved in this paper.The first is to define the concept of long-term care needs more scientifically through comparative analysis at home and abroad,and integrate the evaluation methods of disability grades in the first batch of 15 pilot cities in China,and innovatively define the disability status and the level of disability of the disabled elderly based on the Barthel index rating scale.This lays a theoretical foundation for the accurate prediction of the scale of the long-term care needs of the disabled elderly;Secondly,when predicting and analyzing the scale of long-term care needs of the disabled elderly,based on the scientific definition of the key influencing factors of long-term care needs,this paper fully considers the heterogeneity characteristics of the disabled group,and makes a more accurate classification and prediction of the scale of long-term care needs of the disabled elderly.This provides the latest localized data support for judging the overall scale and overall situation of the long-term care needs of the disabled elderly accurately and reasonably,as well as revealing the urgency and necessity of the long-term care insurance pilot policy;Thirdly,when discussing the relationship between informal care and formal care,this paper takes the lead in using instrumental variable method for empirical analysis,and discusses the influence of the degree of disability on the heterogeneity of the relationship between them.The use of instrumental variable method can accurately identify the alternative relationship between the two care modes for the disabled elderly.Through the accurate identification of the alternative relationship between the two care modes for the disabled elderly,it provides a more reliable practical basis for the scientific implementation of the pilot policy of long-term care insurance;The fourth is to accurately identify the disabled elderly as the research object in the policy evaluation of the local pilot of long-term care insurance.For the first time,we evaluated the policy effect of long-term care insurance in 11 pilot cities in China,and take the lead in discussing the relationship between the development of long-term care insurance and the care structure and the accessibility of care services for the disabled elderly.This provides a more reliable reference for the expansion of the pilot policy and the comprehensive construction of long-term care insurance system. |
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